Healthcare Provider Details

I. General information

NPI: 1982865267
Provider Name (Legal Business Name): STEVEN SEUNGBIN LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 WILSHIRE BOULEVARD, SUITE 1120
LOS ANGELES CA
90036-4201
US

IV. Provider business mailing address

DEPT LA 21559
PASADENA CA
91185-1559
US

V. Phone/Fax

Practice location:
  • Phone: 323-549-3030
  • Fax: 323-549-3049
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number232376
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA107778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: